钨矿作业工人死因分析

Mortality analyses for tungsten miners

目的探讨危害钨矿作业工人健康的主要死因并分析他们与累积粉尘接触量之间的关系。方法以湖南、江西两省6个钨矿1970至1972年之间至少工作1年以上的全部在册职工建立研究队列，随访至2003年底，以全国城市居民年龄别死亡率为参照计算标化死亡比（SMR），采用趋势分析探讨累积粉尘接触量与钨矿作业主要死亡疾病的关系。结果队列共18027人，到2003年底，共随访470722．21人年，死亡6135人，总死亡率为13．03‰。钨矿作业工人死亡的主要疾病按死亡率依次为心血管疾病（3．54‰）、呼吸系统疾病（2．79‰）、恶性肿瘤（2．14‰）和肺结核（1．87‰），这4种疾病死亡人数约占总死亡人数的79．32%.全死因死亡率（13．03‰）明显高于全国平均水平（SMR=1．19,95％CI：1．16～1．22）。死亡率明显升高的疾病为尘肺、肺结核、鼻咽癌、传染病、呼吸系统疾病、心血管疾病和肝癌，SMR分别为79．11，4．11，2．51，2．46，2．00，1．85和1．30。全死因、尘肺、肺结核、呼吸系统疾病和心血管疾病的SMR随累积接尘量升高有明显的上升趋势，差异有统计学意义（P〈0．01）。结论钨矿作业场所粉尘明显危害接尘工人健康，累积粉尘接触量与全死因、肺结核、呼吸系统疾病（尘肺）、心血管疾病标化死亡比之间存在明显的剂量-反应关系。

Objective To investigate the mortality from main causes of death in 6 tungsten miners and explore the effects of cumulative dust exposure on standardized mortality ratios （SMRs） from main causes. Methods A cohort of 18027 workers registered in the employment record from 6 tungsten mines located in Hunan and Jiangxi province and working for at least 1 year was identified for this study. SMRs were calculated based on Chinese national mortality. Trend analysis was used to analyze the effect of cumulative dust exposure on SMRs of main causes of death. Results The cohort was followed up from 1972 to 2003 with an accumulative of 470 722.21 person-years. A total of 6135 workers died, and the mortality was 13.03‰. Cardiovascular disease,respiratory disease,malignant neoplasm and pulmonary tuberculosis accounted for 79.32% of all death. The mortalities of all-causes, pneumoconiosis, pulmonary tuberculosis, nasopharyngeal carcinoma,infectious disease ,respiratory disease,cardiovascular disease and liver cancer were found to be significantly higher than the national average level. Positive dose-response relationship between SMRs and cumulative dust exposure was observed in all-causes, pneumoconiosis, pulmonary tuberculosis, respiratory disease, cardiovascular disease（P〈0.01 ）. Conclusion The mortality from main causes of death for the dust-exposed workers are higher than that for non dust-exposed workers. Positive dose-response relationships are observed between cumulative dust exposure and SMRs from all-causes, respiratory disease（ including silicosis ）, pulmonary tuberculosis and cardiovascular disease.